Holy Family Blackpool 01253 205971

  Holy Family Church Visitor Health Screening Questionnaire

The safety of our clergy, volunteers, employees, customers, families and visitors remains Holy Family Church’s overriding priority. As the corona virus disease 2019 (COVID-19) outbreak continues to evolve and spread Holy Family Church is monitoring the situation closely and will periodically update guidance based on current recommendations from the Centre for Disease Control and the World Health Organisation.


To prevent the spread of COVID-19 and reduce the potential risk of exposure at Holy Family, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in our church. This form sends an email to the parish email account which is viewable by the parish priest. We intend to keep this record for between 21 and 28 days for the purpose of contacting you in the unlikely event of a case of novel covid 2 virus being traced to Holy Family Blackpool. It will not be read for any other purpose or used for any promotion or to contact you to sell you anything or even to give you different information

Thank you for your time.

 

 Name: 

Phone:  

 Email: (optional)


1       Have you been tested for COVID-19 in the last 14 days? Yes         No

2 Have you had close contact with or cared for someone who has been diagnosed with COVID-19 within the last 14 days? Yes         No


3 Have you had any cold or flu-like symptoms in the last 14 days (fever, cough, sore throat, difficulty breathing, loss of taste and smell)?Yes          No